急诊室的故事

ER S03E06

Part 5 July 17, 2020, 11:36 a.m.

所以要给他做核磁
So they're doing an M.R.I.
他们为什么要把梅根带走
Why did they take Megan away?
她就在隔壁这有点挤
She's just next door. It's a little crowded in here.
通知楼上扎克手术完了
Call upstairs, Zach's out of surgery.
他会没事的吗
He's gonna be all right?
他在重症监护室
He's in I.C.U.
我会尽快去看他
I'll check on him as soon as I can.
天呐天呐
Oh, god. Oh, god.
我需要我的丈夫拜托
I need my husband. Please.
在哪...大卫大卫在哪拜托了
Where...? David. Please, where's David? Please.
她的腹部有点硬
Her abdomen's kind of firm.
她吸了很多空气
She swallowed a lot of air.
新生儿可吃不太消
It's a tough call on a newborn.
我们该怎么做呢
What should we do?
好什么情况甘特
All right, what is it, Gant?
我不确定腹部持续肿胀
Well I'm not sure. Abdomen's persistently distended
她一直在哭呼吸率高 60多
She keeps crying. And the resps are high, in the 60s,
但血压脉搏和肤色正常
but the B.P., the pulse and the color's okay.
为什么不插鼻饲管呢
Why didn't you drop an N.G.?
我们觉得...
Well, we considered it...
做粪便检查
Stool guaiac.
-给这么小的宝宝插吗 -好
- In such a small baby? - All right.
不用直肠温度计
Do it off the rectal thermometer.
你没为病人做全面的手术评估甘特医生
You didn't do a full surgical evaluation of the patient, Dr. Gant.
有便潜血
It's positive for blood.
好的准备静脉切开术托盘
All right. Prep a cutdown tray,
交叉配血两个单位然后呼叫基顿
type and cross for two units and page Keaton.
她母亲在哪
Where's her mother?
创伤一室
Trauma one.
我和罗斯医生认为结论尚不明确
Dr. Ross and I thought it was an equivocal exam.
罗斯只是个儿科大夫
Ross is a pediatrician.
如果你自己不明白就去找懂的人问
If you don't know what you're doing call someone who does.
你好我是本顿医生
Hi. I'm Dr. Benton.
您的女儿受了内伤
Your daughter has internal injuries
需要进行手术
that's going to require an operation.
她才出生十天
She's only ten days old.
没关系的
It's okay.
基顿医生会照顾她
Dr. Keaton will be with her
而且她是芝加哥最棒的小儿外科医生
and look, she's the best pediatric surgeon in chicago.
所以我们需要你对
Now, we need your consent
所谓剖腹探查的准许
for what's called an exploratory laparotomy.
我的丈夫在哪
Where's my husband?
我希望他来签字
I want him to sign for it.
她丈夫是个儿科医生
Her husband's a pediatrician.
他现在没法签字
He can't do it right now.
他负责做全家人的医疗决策
He handles all the family medical decisions.
我什么都不懂
I don't know anything about this.
你可以的盖尔
You can do this, Gail.
但我不知道不知道
But I don't know. I don't know.
你的宝宝需要手术
Your baby needs it.
好吧好吧好吧
Okay. Okay. Okay.
切开托盘
Cutdown tray.
使用输液控制器可能需要输血
Use a volutrol. We may have to transfuse.
甘特去准备了我刚把他劝走了
Gant was on track. I just talked him out of it.
好的挂糖盐水
Okay. Hang D-5, quarter normal.
什么情况皮特
What do you think, Peter?
她有急腹症
She has an acute abdomen.
你好漂亮姑娘
Hi, pretty girl.
体征如何
Vitals?
血压80/40 脉搏160
B.P.'s 80/40, pulse 160
呼吸率65 体温38.5
Resps 65, temp's 101.4.
血氧值呢
Pulse ox?
-多么湛蓝的眼睛啊 -空气下92
- Oh, what blue, blue eyes. - 92 room air.
小宝贝血氧太低了
Oh, teacup, that's too low.
给她输氧面罩供氧4升
Let's get her on O2, four liters by mask.
你注意到脐周发红了吗
Did you appreciate the periumbilical redness?
腹部有点紧绷
Abdomen's a little tense.
不不没注意到
No, no, I missed it.
确实容易忽略
Well, it's easy to miss.
为什么要做切开术
Why a cutdown?
找不到静脉
No veins.
22号♥留置针
22 angio.
你处理得很好皮特
This was a nice pickup, Peter.
谢谢
Thank you.
好的
Ah, yes.
进去了
There we go.
我既看不到也摸不到静脉
I couldn't see or feel a vein.
只是凭经验知道在哪而已
Well, it's just a matter of knowing where it is.
给她做侧位X光
Let's get her a cross-table lateral
检查是否有游离气体她可能有穿孔
and check for free air. She may be perfed.
该用什么抗生素呢
Any thoughts on antibiotics?
因为新生儿无需覆盖厌氧菌
Since you don't need anaerobic coverage on newborns
我选氨苄西林和庆大霉素
I'd go with amp and gent.
看来你做了功课
You've been reading.
丹尼斯既然你做了创伤评估
Dennis, since you did the trauma assessment
要不也加入手术跟到底吧
why don't you scrub in and follow the case through.
皮特我们去跟孩子妈聊聊
Peter, let's talk to mom.
好姑娘
Good girl.
好了布拉奇尔先生
There you go, Mr. Brazil.
鲜虾鸡尾酒做好了
Shrimp cocktail time.
我是休伯特·斯金纳加州人体冷冻公♥司♥的
Hubert Skinner, California Cryonics.
布拉奇尔先生
Mr. Brazil.
你有身份证明吗
Do you have some kind of an I.D.?
在这里
It's all there.
立刻给他用1♥0♥0♥0♥0♥单位的肝素
Give him 10,000 units of heparin stat.
我会把他打包
I'll pack him up
然后我们就上路了
and we'll be on our way.
他是医生吗
Is he a doctor?
感觉不是我们怎么办
I don't think so. What do we do?
肝素应该无所谓吧毕竟他已经死了
The heparin can't hurt, him being dead and all.
我为新生儿做横切口
In the newborn I use a transverse abdominal incision.
直肌很薄所以术后痛苦也会减少
The rectus is thin, so there's less pain post-op.
艾德森
Adson.
我们要用呼吸机所以肺不张也没问题
We're using a respirator, so atelectasis isn't an issue.
肺部容量或含气量减少
没错为小家伙止血
Exactly. Zap that little bleeder.
-电刀 -15号♥
- Cautery. - 15 blade.
如果有穿孔
If there's a perforation
当我切开腹膜时会有气体涌出
We should get a gush of air when I nick the peritoneum.
对有的
Yep. There it is.
她的气息更通畅了
She's easier to ventilate.
有极少量出血
Very little bleeding.
丹尼斯我们为什么要尽量避免出血
Dennis, why do we want to keep bleeding to a minimum?
因为输血很危险
Transfusions are dangerous.
由于婴儿的血红蛋白特殊
You can't type and cross match the blood as quickly
我们来不及迅速交叉配血
because of the baby's fetal hemoglobin.
找到了空肠穿孔
There it is-- perfed jejunum.
你把实习生教得很好
You're teaching your interns well.
他做完了
He's in and out.
核磁结果正常
M.R.I. was normal.
赫利希医生还记得我的名字吗
Dr. Herlihy, do you remember my name?
我的妻子和孩子在哪
Where's my wife and kids?
我是马克·格林
I'm Mark Greene.
你一家人遭遇了车祸
Your family was involved in a traffic accident.
你妻子在急诊室里她胫腓骨骨折
Your wife's in the E.R. with a tib-fib fracture.
扎克面部受创腹腔积血
Zach had facial trauma and hemoperitoneum.
他已经手术完毕在重症监护室里
He's out of surgery, in I.C.U.
他的脾受伤了
Was it his spleen?
不是胰腺受伤
No. Pancreatic injury.
梅根呢
What about Megan?
梅根被送去检查有没有肠道破裂